| NPI | 1902839715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED STAKEBAKE CFO 435-753-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: UT 1259851703) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-12-08 |